Wealth inequalities in timely postnatal care in Malawi: how much do antenatal care and place of delivery explain?

Wait 5 sec.

Background Postnatal care (PNC) is important for maternal and newborn health, but socioeconomic inequalities may limit timely access. In Malawi, evidence on PNC timing and the pathways linking household wealth to PNC is limited. We examined socioeconomic inequalities in timely PNC and whether antenatal care (ANC) and delivery-facility type accounted for part of the wealth gradient. Methodology We analysed 4,726 women with a live birth in the previous 24 months from the 2024 Malawi Demographic and Health Survey. PNC was timely when the first check occurred within two days of birth, delayed when it occurred later, and absent when no qualifying check was reported. Survey-weighted multinomial logistic regression examined associations between household wealth and PNC timing, with sequential adjustment for maternal education, ANC and place of delivery. The slope index of inequality (SII) and relative index of inequality (RII) summarised inequality. Pathway analyses examined ANC and delivery-facility type as mediators. Results Overall, 66.6% of women received timely PNC, 5.1% delayed PNC and 28.3% no PNC. Unadjusted, women in the richer and richest wealth quintiles had lower relative risk ratios (RRR) of no PNC than women in the poorest quintile (RRR 0.56 and 0.57, respectively). After full adjustment, the richer group remained less likely to have no PNC (RRR 0.67, 95% CI 0.50-0.89). Wealth inequality persisted (SII -8.4 percentage points, 95% CI -14.8 to -2.0; RII 0.74, 95% CI 0.59-0.93). Among all births, 26.6% of the wealth association with no PNC was accounted for by ANC and place of delivery, primarily home delivery. Conclusion Timely PNC remains unequally distributed by household wealth in Malawi. The findings suggest that reducing missed PNC opportunities requires attention to socioeconomic barriers and continuity from pregnancy through delivery and the postnatal period.